Do Latino and non-Latino grocery stores differ in the availability and affordability of healthy food items in a low-income, metropolitan region?

OBJECTIVE: To compare non-ethnically based supermarkets and Latino grocery stores (tiendas) in a lower-income region with regard to the availability, quality and cost of several healthy v. unhealthy food items. DESIGN: A cross-sectional study conducted by three independent observers to audit twenty-five grocery stores identified as the main source of groceries for 80 % of Latino families enrolled in a childhood obesity study. Stores were classified as supermarkets and tiendas on the basis of key characteristics. SETTING: South San Diego County. SUBJECTS: Ten tiendas and fifteen supermarkets. RESULTS: Tiendas were smaller than supermarkets (five v. twelve aisles, P = 0·003). Availability of fresh produce did not differ by store type; quality differed for one fruit item. Price per unit (pound or piece) was lower in tiendas for most fresh produce. The cost of meeting the US Department of Agriculture's recommended weekly servings of produce based on an 8368 kJ (2000 kcal)/d diet was $US 3·00 lower in tiendas compared with supermarkets (P < 0·001). The cost of 1 gallon of skimmed milk was significantly higher in tiendas ($US 3·29 v. $US 2·69; P = 0·005) and lean (7 % fat) ground beef was available in only one tienda (10 %) compared with ten (67 %) supermarkets (P = 0·01). CONCLUSIONS: Barriers remain in the ability to purchase healthier dairy and meat options in tiendas; the same is not true for produce. These results highlight the potential that tiendas have in improving access to quality, fresh produce within lower-income communities. However, efforts are needed to increase the access and affordability of healthy dairy and meat products.

Westernization, intuitive eating, and BMI: an exploration of Jordanian adolescents.

The purpose of this study was to validate the Arabic-version of the adapted Marin Bidimensional Acculturation Scale and investigate the relationship between Westernization, intuitive eating, and body mass index (BMI) in a sample of Jordanian female adolescents. A total of 199 subjects between the ages of 11-18 were surveyed. Participants who scored higher on the Arabic domain exhibited higher Intuitive Eating Scale (IES) intrinsic subscale scores (r = 0.147, P = 0.048) suggesting that those who are more orientated toward Arabic culture may respond more naturally to physical hunger cues than their more Westernized counterparts. Reinforcing intuitive eating attitudes and behaviors and emphasizing body ideals resonant with the Arabic culture may propagate the continuation of intuitive eating in this population, potentially reducing the risk of obesity and other nutrition-related non-communicable diseases.

Perceptions of young Jordanian adults to proposed anti-tobacco pictorial warning labels.

BACKGROUND: In commitment to the Framework Convention on Tobacco Control (FCTC), four new pictorial warnings are now being proposed for display on cigarette packages sold in Jordan. The aim of this study was to gauge the immediate perceptions of young Jordanian adults towards these new pictorials and compare these perceptions to those of the pictorial currently being used in the country. METHODS: A cross-sectional survey was conducted on a convenience sample of youth aged 17-26. The interviewer-administered survey gauged participants' perceptions of salience, fear elicitation, and gained information as well as participants' motivation to remain non-smokers or quit smoking after viewing each of the four proposed new pictorials as well as the current pictorial used in Jordan. Perceptions regarding each new pictorial were compared to the current pictorial. RESULTS: A total of 450 surveys were included in the analysis. The sample (mean age 20.9) was 51.6% female and 31.3% cigarette (regular or occasional) smokers. In smokers, only one proposed pictorial had significantly more smokers perceiving it as salient or adding to information when compared to the current pictorial. More smokers reported fear when observing the proposed pictorials compared with current pictorial, but overall proportions reporting fear were generally less than 50%. Furthermore, all new pictorials motivated significantly more smokers to consider quitting compared with the current pictorial; however, the overall proportion of smokers reporting motivation was < 25%. Among nonsmokers, significantly more respondents perceived the new pictorials as salient and fear-eliciting compared to the old pictorial, but there were no major differences in information added. Motivation to remain non-smokers was comparable between the old and new pictorials. CONCLUSION: Given the variability of response across both smokers and nonsmokers, and across the three elements of perception (salience, added information, fear) for each pictorial, further testing of the pictorials in a more diverse sample of Jordanian young adults prior to launch is recommended.

A comparative study of the culture of thinness and nutrition transition in university females in four countries.

The purpose of this study was to examine the nutrition transition in four countries with respect to body dissatisfaction and eating styles. The target population for this study was college students in China (n=207), Japan (n=865), Jordan (n=322), and the United States (n=432). A cross-sectional survey was used to assess eating styles, disordered eating attitudes and behaviors, body esteem and dissatisfaction, and media influence. Results indicated that the Chinese sample was in an earlier stage of the nutrition transition, followed by Japan, Jordan, and the US. Interestingly, Jordanian and Chinese students exhibited the lowest level of body dissatisfaction. However, Jordanian students exhibited high levels of restrained eating similar to those seen in the Japanese and American students. The Japanese sample demonstrated a complex relationship between the culture of thinness, body dissatisfaction and eating styles. However the US sample reflected the expected levels of body dissatisfaction, high levels of restrained eating, emotional eating, and disordered eating attitudes and behaviors. Implications and suggestions for further research are discussed.

Young urban women and the nutrition transition in Jordan.

OBJECTIVE: To determine the nutrition transition stage of female Jordanian college students. DESIGN: A cross-sectional survey was used to assess eating styles, disordered eating attitudes and behaviours, body esteem and dissatisfaction, and media influence. SETTING: Public and private universities in Jordan. SUBJECTS: A total of 255 subjects were recruited through a government-initiated youth campaign. RESULTS: The majority of participants had a normal BMI (70.6%) with almost all (99.4%) reporting restrained eating behaviour. Scores on the Eating Attitudes Test (EAT-26) indicated that 45.2% of these female college students should be screening for eating disorders. Subscales of the Body Esteem Scale (BES) showed that these women did not have substantial body esteem issues and mean scores on the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) indicated that overall these women did not feel the media was dictating the way their body should look. Where Jordanian women did feel pressure from Western media, there was a 6.7-fold increase in the likelihood that they wanted to lose weight. In addition, 48.2% of the female college students desired to lose weight and 14.4% desired weight gain, indicating a certain level of body dissatisfaction. CONCLUSIONS: With low levels of overweight and obesity and a propensity towards eating based on external hunger cues, college-aged Jordanian women may be less advanced in their development through the nutrition transition than the general population of women. However, high levels of restrained eating and disordered eating attitudes and behaviours indicate the need for an intervention to address healthy weight-loss strategies, assess eating disorders and help maintain healthy body esteem.

Young urban women and the nutrition transition in China: a familiar pattern emerges.

The purpose of this study was to assess the nutrition transition being experienced by urban Chinese college females. The self-administered cross-sectional survey was given to female students attending universities in the urban area of Xi'an, China. The survey was a collection of previously validated instruments measuring motivations for eating, disordered attitudes and behaviors, societal and media influences on body image and eating disturbances, body esteem, body dissatisfaction, and demographic questions. Results from 207 Chinese college females indicated that they had high levels of dietary restraint, despite the large proportion of participants who were considered underweight and normal weight. In addition, the results indicated that these college females ate primarily based on hunger cues. They also had a strong desire to lose weight sometimes to ultra thin and unhealthy levels, but with only moderate levels of disordered eating attitudes and behaviors. It appears that for participants in this study, at their current point in the nutrition transition, the full negative impact of Americanized media may not yet be fully internalized. The study has revealed a need for the development of health education programs to promote healthy eating styles and appropriate dieting behaviors. Future research needs to develop strategies for better understanding the impact of Americanization on the body image of women in this type of transitional population.

Chronic respiratory illnesses in Jordan: pulmonary physicians' experiences in risk reduction.

Chronic respiratory diseases are on the rise in Jordan. However, there is limited research on the symptoms reported by patients, the triggers associated with their illnesses, and the health education efforts of pulmonary physicians. Thus, the purpose of this qualitative study was to understand these issues from physicians' perspectives. Fourteen face-to-face interviews were done with pulmonary physicians in their clinics in Amman, Jordan. Physicians indicated that cultural barriers existed such as the social acceptance of smoking, prevalence of olive trees, and cultural practices such as kissing as a form of greeting. In addition, health education materials were scarce and of poor quality. Implications for health education are discussed.

Determining responsibility for smoking in society: accountability continuum for Jordanian college students and its implication on FCTC implementation.

As one of the first countries to ratify the WHO Framework Convention on Tobacco Control, Jordan has signaled an interest in stronger anti-tobacco restrictions. This study examines whether Jordanian students believe smoking is an individual right or a social issue, and if they would support more stringent policies and enforcement. Undergraduate Jordanian students (n = 1211) from public and private universities completed the survey. Never smokers scored significantly higher on smoking being a social issue that required public policy response (p-value < .001); whereas smokers scored significantly higher with all individual right items. Ample opportunity exists for developing and enforcing stronger tobacco policies both on college campus and generally in the country. However, increasing tobacco taxes may need to be preceded by health communication campaigns that increase knowledge of the effectiveness of the tobacco tax in reducing use and resultant premature deaths.

The nutrition transition in Jordan: the political, economic and food consumption contexts.

This paper describes and analyzes the nutrition transition in Jordan. The nutrition transition is shifting from undernutrition of a population to a diet high in fat, sugar, and refined carbohydrates (overnutrition) and corresponding premature morbidity and mortality from ensuing chronic diseases. The paper reviews and examines secondary data on demographic, epidemiological, economic, social, and dietary changes in the region. Jordan is moving through the nutrition transition at a rapid pace. Demographic, epidemiological, economic, and social changes have been accompanied by changes in diet, food expenditure, and general health. Although mortality rates have dropped significantly, fertility rates still remain high at 3.6 children per woman, especially compared to other countries in the region. Urbanization has increased rapidly from 46% of the population residing in urban areas in 1965 to 75% currently. Declines in real per capita income have created a state in which 27% of families live under the poverty line. Dietary changes in the region, due in part to changes in food availability over the last 40 years, include a general rise in caloric intake (from 2,165 Kcals in 1965 to 3,161 Kcals in 1997) with an increasing percentage of energy supply coming from fats and cereals. Undernutrition and chronic rates of malnutrition are low compared to other developing countries; however, various sources reveal that overweight and obesity are on the rise. Obesity in Jordan tends to be higher among women (16%) than among men (10%), with a much higher prevalence of obesity among uneducated women (50%). In conclusion, overweight and obesity are an emerging problem in Jordan, especially for women. There is a high prevalence of risk factors associated with diet-related non-communicable diseases among both men and women.

Health education's role in framing pornography as a public health issue: local and national strategies with international implications.

Pornography is a public health issue. However, since the US Surgeon General's workshop on pornography and public health reached a consensus statement about the impacts of pornography in 1986, few policy actions have been taken to deal with this public health problem, and intense discussion surrounding the regulation of pornography has continued. This debate spans a continuum between individual rights on one extreme and complete restriction of such material for society's good on the other extreme. However, during this same period much research has been done on the impacts of pornography on children and adults. This paper focuses on reviewing the effects of pornography on society including women, children, and consumers, and includes discussion on the current and failed policies aimed at regulating pornography. The growing phenomenon of Internet pornography use is discussed in depth, and specific policy ideas pertaining to Internet pornography are presented from a public health perspective.

Current smoking practices among Jordanian college students: a pilot study.

This pilot study gauges the smoking rates among college students in Jordan, attitudes toward tobacco policies, knowledge of smoking hazards, and identifies methods of quitting for former smokers. The sample (n=296) was taken from students attending a General Education course at the University of Jordan. Results show that the majority of respondents (70.3%) had never smoked, 2.8% were former smokers, while 26.9% were current smokers. For former smokers, the main reported reason for quitting was concern for health (63.6%) and the two methods used to quit smoking were: 1) cold turkey (by themselves) (66. 7%); and 2) cut-down smoking and then quit by themselves (33.3%). In addition, a higher level of knowledge related to health effects of tobacco and a higher need for tobacco-related policies was identified by the former/never smokers. Implications for health education are discussed.

The impact of body mass index and Western advertising and media on eating style, body image and nutrition transition among Jordanian women.

OBJECTIVES: To identify the impact of body mass index (BMI) and Western advertising and media on the stage of the nutrition transition among Jordanian women, and to evaluate their impact on eating styles and body image. DESIGN: A randomised cross-sectional survey that included a variety of culturally measured Likert-type scales and body size images. In addition, BMI was calculated based on measured height and weight. SETTING: In the homes of the participants. The data were collected by female interviewers who worked for the Jordan Department of Statistics. SUBJECTS: The sample was based on a random and representative selection of 800 mostly urban Jordanian women. A pre-test sample of 100 women was also used to validate the instruments. RESULTS: Women tended to agree that they ate based on emotional cues. They had high levels of disordered eating attitudes and behaviours and 42.1% were considered restrained eaters. However, these women also had higher than expected body esteem levels and desired a healthy body size. As expected, being obese was associated with a desire to lose weight, being a restrained and emotional eater, and having more disordered eating attitudes and behaviours. Similarly, Western advertising and media were associated with restrained and emotional eating, desired weight loss, and disordered eating attitudes and behaviours. CONCLUSIONS: There is a need to develop health education materials that explain the influence of obesity on health and the negative psychological and physical consequences of restrained and emotional eating, building on the current cultural preferences of healthy body size. Further implications and suggestions for future research are discussed.

Validation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among a random sample of Jordanian women.

Measuring the impact of westernization on body image is an important element in understanding body dissatisfaction and eating disorders in countries undergoing cultural transitions. The purpose of this study was to evaluate the validity and reliability of the Sociocultural Attitudes Towards Appearance Questionnaire-3, a measure of societal and media impacts on body image, in a non-western population. Factor analyses identified the same four subscales found in the original validation with high Cronbach's alpha coefficients and Guttman split-half coefficients, and low item cross-loadings. Furthermore, mean score comparisons by demographic variables on each subscale indicated that subscale scores were only affected by age. The results suggest that the Sociocultural Attitudes Towards Appearance Questionnaire-3 is a valid and reliable instrument for Jordanian women. The high level of validity and reliability for this population lends support for the possible use of this scale in other non-western populations after appropriate pretesting.

Intuitive eating and the nutrition transition in Asia.

Current models of the nutrition transition focus on demographic changes and economic development. A further influence may be the adoption of western-based perceptions of beauty that lead to potentially harmful eating behaviours which contribute to overweight, obesity, and eating disorders. This paper proposes a comprehensive model of the nutrition transition that includes western influences on perceived attractiveness and subsequent eating styles. An exploratory test of this model for Asian countries explores differences in intuitive eating as a function of economic development and the adoption of western standards of beauty. The intuitive eating scale (IES), a measure of food consumption that is primarily characterized by the satisfaction of physical hunger, was used to evaluate agreement with intuitive eating principles in the US and four Asian countries (Japan, Thailand, the Philippines, and China). Although intuitive eating scores in the US and Thailand failed to follow predicted patterns on two of the four IES subscales, scores for the other two IES subscales and the total IES score followed predicted patterns for Asian countries. Intuitive eating appears to be a valid, measurable concept that is correlated with economic development and levels of western influence in Asian countries. The tentative findings of this exploratory study support further evaluation of cultural influences as an important component of the nutrition transition.

A cross-cultural analysis of 'motivation for eating' as a potential factor in the emergence of global obesity: Japan and the United States.

This exploratory study compared motivation for eating between individuals from two different cultures that have moved through the nutrition transition at different rates and to different degrees. The analysis was based on a convenience sample of 1218 participants aged >or=18 years attending colleges in the US and Japan. The Motivation for Eating Scale (MFES) was used to evaluate different motivations for eating by nation and gender. The MFES consists of 12 items classified into three subscales: emotional, physical and environmental eating. The questionnaire used in the study also included responses about participants' motivation to lose weight, frequency of dieting, presence of previous or existing eating disorders, and frequency of exercise. Results showed no significant differences in the three MFES subscales for men in the US and Japan. For women, however, significant differences were seen for all three subscales. Women in the US were more likely to initiate eating for emotional reasons, while women in Japan were more likely to eat for physical or environmental reasons. Women and men in the US were more likely than the Japanese respondents to eat in response to watching TV or movies. These results suggest that there are national differences in the cultural environment that may impact individual motivations for eating. As such, various cultural perceptions of food should be considered in attempts to understand more fully the mechanics of the nutrition transition as it operates within a given country. By extension, public health policies and health promotion initiatives that are designed to limit the negative impacts of the nutrition transition may benefit from a greater understanding of the larger role that cultural perceptions of food may play in influencing individual motivations for eating.